Evaluation of new investment in psychiatric liaison services at University Hospitals Bristol

In 2014, Bristol Clinical Commissioning Group commissioned University Hospitals Bristol NHS Foundation Trust to extend the operating hours of its liaison psychiatry service at the Bristol Royal Infirmary’s emergency department. The service was extended because most emergency department patients who have self-harmed present outside office hours, and are less likely to receive specialist assessment and aftercare.

This change, from 40 hours over five days to 98 hours over seven days a week, needed an additional investment of around £250,000 per year.

The aims were to:

increase the proportion of patients receiving a NICE-recommended psychosocial assessment when attending the emergency department after self-harming

This study focused on the impact of this service change on self-harm patients because they make up a high proportion of the liaison team’s workload, are the patient group at highest risk of suicide and have detailed data collected about their care through the local self-harm register. It was this detailed data that made this evaluation possible. They also may have to wait in the emergency department or be admitted to hospital if they can’t have a timely psychiatric assessment.

This project was a collaboration with STITCH, the Bristol Health Partners Health Integration Team (HIT) that focuses on improving care for people who self-harm.

Project aims

The study compares the short-term costs of extending the liaison psychiatry service for self-harm patients at the Bristol Royal Infirmary, in a before and after study. We used existing data about acute self-harm episodes.

Anticipated impacts

The results will enable commissioners to explore whether the extra investment increased assessment and provision rates, and reduced hospital admissions for self-harm in the short-term after a self-harm episode.

What we did

We compared attendances at the emergency department during a three month period before the change in operating hours, to attendances during a similar three month period afterwards.

We looked at:

whether patients received an assessment from the liaison psychiatric service

the waiting time until the assessment

whether patients were admitted to a hospital ward

We also estimated average costs per emergency department attendance and compared total costs between the before and after periods.

How we involved people

Staff from the liaison psychiatry service were central to the success of this project. They helped us with their expertise on the data, considering how to carry out the evaluation, and interpreting the results.

What we found and what this means

About 10 per cent more patients received a psychosocial assessment following the change to extended Psychiatric Liaison team operating hours. The waiting time for an assessment decreased by more than three hours. In 2015 with the new hours in place, patients were 20 per cent less likely to re-attend for self-harm within 90 days.

The findings also show that, over a three-month period, the initial investment in the extended service may lead to a saving of £36,150 in emergency department and hospital costs, for this specific group of patients. This equates to £144,600 annually.

However, because the study only covered a short three-month period and relatively small number of patients, these results are preliminary. A larger study is needed to provide stronger evidence on costs and re-attendance.

What next?

Our study will help commissioners across England judge whether further investment in liaison psychiatric services represents value for money.

This study only compared two short periods. It didn’t look at whether there were improvements in patients’ health, or how frequently patients used other services after involvement with the liaison psychiatry service.

The service extension is likely to benefit other patient groups, but we were only able to look at data for patients who had self-harmed.

We hope to do more analysis that includes health outcomes and follow-up care, and look at more patients over a longer period. This further work will allow us to provide a more complete picture and more robust results.

CLAHRC BITE (Brokering Innovation Through Evidence)

Evaluation of new investment in liaison psychiatry services at University Hospitals Bristol

This CLAHRC BITE gives the highlights from this research project in a printable A5 format.

Partners on this project

University Hospitals Bristol NHS Foundation Trust

University Hospitals Bristol NHS Foundation Trust is a dynamic group of hospitals in the heart of Bristol, with over 100 clinical services across nine sites. They offer care to the people of Bristol and the South West, and have an international reputation for cardiac surgery, paediatric services, oncology and bone marrow transplantation and are the largest centre for medical training and research in the South West.

University of Bristol

The University of Bristol is internationally renowned and one of the very best in the UK, due to its outstanding teaching and research, its superb facilities and highly talented students and staff. Its students thrive in a rich academic environment which is informed by world-leading research. It hosts the Elizabeth Blackwell Institute for Health Research.